Binge eating disorder is a newly recognized condition that probably affects millions of Americans. People with binge eating disorder frequently eat large amounts of food while feeling a loss of control over their eating. This disorder is different from binge-purge syndrome (bulimia nervosa) because people with binge eating disorder usually do not purge afterward by vomiting or using laxatives.

How does someone know if he or she has binge
eating disorder?

Most of us overeat from time to time, and many people feel they frequently eat more than they should. Eating large amounts of food, however, does not mean that a person has binge eating disorder. Doctors are still debating the best ways to determine if someone has binge eating disorder. But most people with serious binge eating problems have:

Frequent episodes of eating what others would consider an abnormally large amount of food.

Frequent feelings of being unable to control what or how much is being eaten.

Several of these behaviors or feelings:

Eating much more rapidly than usual.

Eating until uncomfortably full.

Eating large amounts of food, even when not physically hungry.

Eating alone out of embarrassment at the quantity of food being eaten.

Feelings of disgust, depression, or guilt after overeating.

Episodes of binge eating also occur in the eating disorder bulimia nervosa. Persons with bulimia, however, regularly purge, fast, or engage in strenuous exercise after an episode of binge eating. Purging means vomiting or using diuretics (water pills) or laxatives in greater-than-recommended doses to avoid gaining weight. Fasting is not eating for at least 24 hours. Strenuous exercise, in this case, is defined as exercising for more than an hour solely to avoid gaining weight after binge eating. Purging, fasting, and strenuous exercise are dangerous ways to attempt weight control.

How common is binge eating disorder, and who is at risk?

Although it has only recently been recognized as a distinct condition, binge eating disorder is probably the most common eating disorder. Most people with binge eating disorder are obese (more than 20 percent above a healthy body weight), but normal-weight people also can be affected. Binge eating disorder probably affects 2 percent of all adults, or about 1 million to 2 million Americans. Among mildly obese people in self-help or commercial weight loss programs, 10 to 15 percent have binge eating disorder. The disorder is even more common in those with severe obesity.

Binge eating disorder is slightly more common in women, with three women affected for every two men. The disorder affects blacks as often as whites; its frequency in other ethnic groups is not yet known. Obese people with binge eating disorder often became overweight at a younger age than those without the disorder. They also may have more frequent episodes of losing and regaining weight (yo-yo dieting).

What causes binge eating disorder?

The causes of binge eating disorder are still unknown. Up to half of all people with binge eating disorder have a history of depression. Whether depression is a cause or effect of binge eating disorder is unclear. It may be unrelated. Many people report that anger, sadness, boredom, anxiety or other negative emotions can trigger a binge episode. Impulsive behavior and certain other psychological problems may be more common in people with binge eating disorder.

Dieting's effect on binge eating disorder is also unclear. While findings vary, early research suggests that about half of all people with binge eating disorder had binge episodes before they started to diet. Still, strict dieting may worsen binge eating in some people.

Researchers also are looking into how brain chemicals and metabolism (the way the body burns calories) affect binge eating disorder. These areas of research are still in the early stages.

What are the complications of binge eating disorder?

The major complications of binge eating disorder are the diseases that accompany obesity. These include diabetes, high blood pressure, high cholesterol levels, gallbladder disease, heart disease, and certain types of cancer.

People with binge eating disorder are extremely distressed by their binge eating. Most have tried to control it on their own but have not succeeded for very long. Some people miss work, school, or social activities to binge eat. Obese people with binge eating disorder often feel bad about themselves, are preoccupied with their appearance, and may avoid social gatherings. Most feel ashamed and try to hide their problem. Often they are so successful that close family members and friends don't know they binge eat.

Should people with binge eating disorder try to diet?

People who are not overweight or only mildly obese should probably avoid dieting, since strict dieting may worsen binge eating. However, many people with binge eating disorder are severely obese and have medical problems related to their weight. For these people, losing weight and keeping it off are important treatment goals. Most people with binge eating disorder, whether or not they want to lose weight, may benefit from treatment that addresses their eating behavior.

What treatment is available for people with binge eating disorder?

Several studies have found that people with binge eating disorder may find it harder than other people to stay in weight loss treatment. Binge eaters also may be more likely to regain weight quickly. For these reasons, people with the disorder may require treatment that focuses on their binge eating before they try to lose weight.
Even those who are not overweight are frequently distressed by their binge eating and may benefit from treatment.

Several methods are being used to treat binge eating disorder. Cognitive-behavioral therapy teaches patients techniques to monitor and change their eating habits as well as to change the way they respond to difficult situations. Interpersonal psychotherapy helps people examine their relationships with friends and family and to make changes in problem areas. Treatment with medications such as antidepressants may be helpful for some individuals.
Self-help groups also may be a source of support. Researchers are still trying to determine which method or combination of methods is the most effective in controlling binge eating disorder. The type of treatment that is best for an individual is a matter for discussion between the patient and his
or her health care provider.

If you believe you have binge eating disorder, it's important you realize that you are not alone. Most people who have the disorder have tried unsuccessfully to control it on their own. You may want to seek professional treatment.

Additional Readings

Marcus MD. "Binge Eating in Obesity." In: Fairburn CG, Wilson GT (eds). Binge eating: nature, assessment, and treatment. New York: Guilford Press. This chapter reviews the scientific knowledge about binge eating disorder. It is geared to health professionals who do research on and treat patients with binge eating problems. The book is scheduled for publication in Spring 1993.

de Zwaan MD, Mitchell JE. "Binge Eating in the Obese." Annals of Medicine. Vol. 24, pp. 303-308, 1992. This review article is written for health professionals. It describes previous studies of binge eating in obese individuals and how they differ from obese people who do not binge eat.